Patient concerns:: They represents about 2% of all soft tissue sarcoma, which can often metastasize through the hematogenous route. The radiological features have been analyzed in 4 patients with metastatic angiosarcoma in the chest.

Diagnoses:: The main radiologic findings included nodules, cysts, nodules with halo sign, and vascular tree-in-bud. Morphologic features, as observed in the histologic specimen, have been correlated with radiologic appearance.

Lessons:: Metastatic angiosarcomas to the lung are characterized by a wide variety of radiologic appearances that can be very characteristic. Computed tomographic findings observed include bilateral solid nodules, cystic, and bullous lesions sometimes associated with spontaneous hemopneumothoraces.

Figure 3: Patient 2. PA Chest X ray. Presence of 2 contiguous opacities in the middle zone of right hemithorax, both subpleural and with an obtuse angle with the pleural margin, suggesting the feature of pleural lesions.

Mentions:
A 55-year-old male (Patient 2) underwent resection of an enlarging mass of the right foot. The specimen showed an epithelioid neoplasm with positivity for CD31 and a focal positivity for cytokeratin AE1/AE3. CD34 was negative. The proliferative activity evaluated by Ki-67 antibody was about 60%. The histological findings were highly suggestive of epithelioid angiosarcoma. After a minor trauma, 1 month later, the patient presented to the Emergency Department because of an intense chest pain on the right side. Chest X-rays documented a large right pleural effusion, and no rib fractures were present (Fig. 3). Thoracentesis showed a hemorrhagic pleural effusion with reactive mesothelial cells seen cytologically. CT scan with contrast showed 2 adjacent parietal pleural lesions measuring 75 and 15 mm in greatest dimension, respectively (Fig. 4). These lesions had smooth margins and did not cause erosion on the ribs, whereas they completely obliterated the extrapleural space. In addition, moderate diffuse thickening of the pleura was visible in the whole right hemithorax. CT-guided biopsy of 1 of the lesions confirmed metastatic angiosarcoma (Fig. 5). Multiple sites of pathological uptake were then confirmed with PET-CT in the right hemithorax suggesting multiple secondary pleural metastases. Uptake was also visible in the right foot, suggesting a local recurrence.

Figure 3: Patient 2. PA Chest X ray. Presence of 2 contiguous opacities in the middle zone of right hemithorax, both subpleural and with an obtuse angle with the pleural margin, suggesting the feature of pleural lesions.

Mentions:
A 55-year-old male (Patient 2) underwent resection of an enlarging mass of the right foot. The specimen showed an epithelioid neoplasm with positivity for CD31 and a focal positivity for cytokeratin AE1/AE3. CD34 was negative. The proliferative activity evaluated by Ki-67 antibody was about 60%. The histological findings were highly suggestive of epithelioid angiosarcoma. After a minor trauma, 1 month later, the patient presented to the Emergency Department because of an intense chest pain on the right side. Chest X-rays documented a large right pleural effusion, and no rib fractures were present (Fig. 3). Thoracentesis showed a hemorrhagic pleural effusion with reactive mesothelial cells seen cytologically. CT scan with contrast showed 2 adjacent parietal pleural lesions measuring 75 and 15 mm in greatest dimension, respectively (Fig. 4). These lesions had smooth margins and did not cause erosion on the ribs, whereas they completely obliterated the extrapleural space. In addition, moderate diffuse thickening of the pleura was visible in the whole right hemithorax. CT-guided biopsy of 1 of the lesions confirmed metastatic angiosarcoma (Fig. 5). Multiple sites of pathological uptake were then confirmed with PET-CT in the right hemithorax suggesting multiple secondary pleural metastases. Uptake was also visible in the right foot, suggesting a local recurrence.

Patient concerns:: They represents about 2% of all soft tissue sarcoma, which can often metastasize through the hematogenous route. The radiological features have been analyzed in 4 patients with metastatic angiosarcoma in the chest.

Diagnoses:: The main radiologic findings included nodules, cysts, nodules with halo sign, and vascular tree-in-bud. Morphologic features, as observed in the histologic specimen, have been correlated with radiologic appearance.

Lessons:: Metastatic angiosarcomas to the lung are characterized by a wide variety of radiologic appearances that can be very characteristic. Computed tomographic findings observed include bilateral solid nodules, cystic, and bullous lesions sometimes associated with spontaneous hemopneumothoraces.